Health care a right or privilege
- page 5

This is a current discussion topic for a masters class. Is health care a right or privilege? What do you think? What do you think about the Affordable Care Act? Do we need universal health care? The...
Read More

I'm as baffled as anyone else if healthcare should be a pure "right" and what the consequences of that logic are (be careful what you with for!). Europe is broke and experiences extensive rationing. So, as a result, they have a two tiered system where the wealthy have lots of (maybe excessive) "care" and the proles get the basics but no frills. Sloan-Kettering in New York gets a big portion of its business from foreigners. I tend of thing of health-care as a right but then it gets sticky. Right to what? A previous poster wants to be able to pick all her doctors and dictate what tests she should receive. Should a 90 year old get a CABG?. Should a 20 week fetus be resuscitated? The list is endless. Should the wealthy be able to buy their way out of the government policy? Who does that leave to take care of us proles?

These are big questions for sure, and could be argued back and forth for a long time. But in practice, when the patient is in front of you, it comes down to clinical judgement. Is this procedure or course of action going to benefit this patient? I still don't really know what people are meaning by rationing. If it means a person who needs an urgent procedure can't get it, then no we don't have rationing. If it means that there is a finite number of times you can see a doctor in a given period, then no we don't have rationing.

If it means there are waiting periods for some elective procedures then yes, we have rationing. If it means not every hospital has the ability to do certain surgeries or procedures then yes, we have rationing. If you live in 'the bush' or a regional area you may well have to travel several hundred kilometres to the city for open heart surgery or even radiotherapy. This can be difficult for people but in a large but sparsely populated country like Australia it's not feasible to have every single thing available within easy reach of everyone.

I suppose it's remotely possible that I could wake up tomorrow to find that the government has decided that from now on, CABGs (or knee replacements) are not 'allowed' for anyone over a certain age. But I can't see it happening, it's ridiculous. It's just not an issue, not something that people worry about or even think about. But just suppose it did happen, it still wouldn't mean that CABGs weren't allowed for 90-year-olds, it would mean they wouldn't be funded by the government.

I get the feeling that some are thinking that the result of universal coverage is that everyone is somehow brought down the same level but I don't see it that way - it's about bringing everyone up to a certain level, that health issues are addressed before they become an emergency (as far as that is possible) and that the population is as healthy as they can be. If a person wants additional private health insurance they purchase it directly from a health insurance fund. Health funds are not allowed to charge differently according to one's health history or the likelihood or otherwise of future health problems. Private health insurance won't get you more procedures (how many do you want??), it might get you a 'nicer' room and a shorter waiting period for your elective procedure though.

This is a very simplistic comparison, but I see it a bit like economy versus business class - everyone is getting to the same place safely, some think it's worth paying for, and can afford, a bit more comfort along the way. Sometimes, unfortunately, you have to catch the slow, crowded train - horrible compared to the plane, but you'll still get there. In my mind, it's better than a system where it's pay for first class or stay at home.

Get the hottest topics every week!

These are big questions for sure, and could be argued back and forth for a long time. But in practice, when the patient is in front of you, it comes down to clinical judgement. Is this procedure or course of action going to benefit this patient? I still don't really know what people are meaning by rationing. If it means a person who needs an urgent procedure can't get it, then no we don't have rationing. If it means that there is a finite number of times you can see a doctor in a given period, then no we don't have rationing.

If it means there are waiting periods for some elective procedures then yes, we have rationing. If it means not every hospital has the ability to do certain surgeries or procedures then yes, we have rationing. If you live in 'the bush' or a regional area you may well have to travel several hundred kilometres to the city for open heart surgery or even radiotherapy. This can be difficult for people but in a large but sparsely populated country like Australia it's not feasible to have every single thing available within easy reach of everyone.

I suppose it's remotely possible that I could wake up tomorrow to find that the government has decided that from now on, CABGs (or knee replacements) are not 'allowed' for anyone over a certain age. But I can't see it happening, it's ridiculous. It's just not an issue, not something that people worry about or even think about. But just suppose it did happen, it still wouldn't mean that CABGs weren't allowed for 90-year-olds, it would mean they wouldn't be funded by the government.

I get the feeling that some are thinking that the result of universal coverage is that everyone is somehow brought down the same level but I don't see it that way - it's about bringing everyone up to a certain level, that health issues are addressed before they become an emergency (as far as that is possible) and that the population is as healthy as they can be. If a person wants additional private health insurance they purchase it directly from a health insurance fund. Health funds are not allowed to charge differently according to one's health history or the likelihood or otherwise of future health problems. Private health insurance won't get you more procedures (how many do you want??), it might get you a 'nicer' room and a shorter waiting period for your elective procedure though.

This is a very simplistic comparison, but I see it a bit like economy versus business class - everyone is getting to the same place safely, some think it's worth paying for, and can afford, a bit more comfort along the way. Sometimes, unfortunately, you have to catch the slow, crowded train - horrible compared to the plane, but you'll still get there. In my mind, it's better than a system where it's pay for first class or stay at home.

It must've been on another thread where I discussed doing the case that involved a fem-pop on an 88 year old demented patient. By no means can she care for those tiny, fragile little stitches post-op. This long, tedious procedure is statistically of no benefit to the patient but we do it. The 90 year old will receive very little benefit from the CABG and will probably never make a decent recovery. But in the states, we do these cases because every everyone's making money. Obviously in a country where doctors are not paid on a per-case basis, things are going to be VERY different. We do many extraordinary, futile procedures here just because we CAN...and some get paid quite nicely for doing them.

I did read about your lady with the fem-pop Subee, I remember wondering who gave consent.

All universal coverage talk aside, maybe it's time for a public education campaign showing exactly what happens when elderly people with dementia or even just some mild confusion are admitted to hospital. With the best will in the world, the change in routine and the loud, busy and unfamiliar environment does more harm than good all too often.

I've got a bit of a theory that when relatives say 'do everything' they really mean do everything that's reasonable. I also think events sort of overtake people a bit, and when no-one says 'look, I don't think this in your mother / father / husband / wife's best interests' it's probably fair enough for the relative to think well, this must be the right path. I think they look at us and think we must know something they don't so they sit at the bedside pretending to be okay with what's happening. Meanwhile we're looking at them waiting for them to speak up so it's all fraught with misunderstandings and swirling with unspoken thoughts and questions and fears.

Personally, I believe it depends on how you interpret the Constitution. We are guaranteed the right to life--how can we have life if we do not have health? How can we maintain health without health care? Also, I believe health care as a right falls under the constitutional directive of "providing for the general welfare." But I'm just one of those people that values human lives over corporate profits and individual wealth (ie, not a Republican).

I did read about your lady with the fem-pop Subee, I remember wondering who gave consent.

All universal coverage talk aside, maybe it's time for a public education campaign showing exactly what happens when elderly people with dementia or even just some mild confusion are admitted to hospital. With the best will in the world, the change in routine and the loud, busy and unfamiliar environment does more harm than good all too often.

I've got a bit of a theory that when relatives say 'do everything' they really mean do everything that's reasonable. I also think events sort of overtake people a bit, and when no-one says 'look, I don't think this in your mother / father / husband / wife's best interests' it's probably fair enough for the relative to think well, this must be the right path. I think they look at us and think we must know something they don't so they sit at the bedside pretending to be okay with what's happening. Meanwhile we're looking at them waiting for them to speak up so it's all fraught with misunderstandings and swirling with unspoken thoughts and

questions and fears.

And I take every opportunity to educate people about the pitfalls of our healthcare system, having a health care proxy, etc. But when these patients come to the OR (with their phone consents from a relative) there's not much you can do at that point except give the surgeon a hard time. Why isn't AARP making this an issue? I've never picked up one of their magazines filled with fabulous looking 50 year olds and seen one article about going gently into that good night. What really infuriates me about Obamacare is the fact that it was hushed, rushed and done in secrecy. Certainly the public is worthy of a nice, long public debate where some education could happen.

Mark my word...... rather its education, health care, energy, or any major life affecting aspect of life, to fix the problem you must first do one thing: GET THE FEDERAL GOVERNMENT OUT. I do not know the "solution" to the problems but booting the feds out of medicine altogether would get us off to a great start.

Government run insurance spends ~6% on administrative overhead, while private insurance spends ~20-30% in administrative overhead.

A socialist system is where the government owns the means of production. That would entail the government owning hospitals, clinics, insurance and employing all health care workers. UHC can be achieved without a completely socialized system.

Hardly any system in the world is actually socialist, except the VA here in the US. (the VA achieves some of the highest quality care standards in the world, at around two-thirds the cost)

A system like Germany and Switzerland would more accurately represent health care under the PPACA. (e.g. Private system, including insurance - where citizens are mandated to purchase insurance)

Health care markets are not freely competitive by the very nature of the industry; (see Kenneth Arrow health economics) asymmetry of information, supply and demand are not independent (physicians supply information, e.g. the diagnosis, and demand treatment), uncertainty (can't predict illness or accidents), and barriers to entry in the market place (physicians, nurses, etc, must be educated and licensed). The only way "free market principles" would work in health care is in a nation full of physicians. That is not to say that the government needs to take over the industry completely, but that government should step in where the market fails and make it more efficient.